{"id":"F2017L00003","name":"Statement of Principles concerning cirrhosis of the liver (Balance of Probabilities) (No. 2 of 2017)","slug":"statement-of-principles-concerning-cirrhosis-of-the-liver-balance-of-probabilities-no-2-of-2017","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":439074,"registerId":"F2017L00003-fast-fetch-1775955225980","compilationNumber":null,"startDate":"2026-04-12","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"1","sectionType":"section","heading":"Statement of Principles concerning cirrhosis of the liver (Balance of Probabilities) (No. 2 of 2017)","content":"---\nmeta-content-style-type: text/css\nmeta-content-type: application/xhtml+xml; charset=utf-8\nmeta-generator: Aspose.Words for .NET 20.2\n---\n\n?xml version=\"1.0\" encoding=\"utf-8\" standalone=\"no\"?>\n\n![RMA-Red](image.001.jpeg)\n\n \n\nStatement of Principles\n\nconcerning\n\nCIRRHOSIS OF THE LIVER  (Balance of Probabilities)\n\n(No. 2 of 2017)\n\nThe Repatriation Medical Authority determines the following Statement of Principles under subsection 196B(3) of the Veterans' Entitlements Act 1986.\n\n \n\nDated                                                                       20 December 2016\n\n \n\n \n\n \n\n \n\n \n\nThe Common Seal of the  Repatriation Medical Authority  was affixed to this instrument  at the direction of:\n\n![](image.002.png)\n\n \n\n \n\n \n\n \n\nProfessor Nicholas Saunders AO\n\nChairperson\n\n \n\n   \n\n\nContents\n\n1 Name\n\n2 Commencement\n\n3 Authority\n\n4 Revocation\n\n5 Application\n\n6 Definitions\n\n7 Kind of injury, disease or death to which this Statement of Principles relates\n\n8 Basis for determining the factors\n\n9 Factors that must exist\n\n10 Relationship to service\n\n11 Factors referring to an injury or disease covered by another Statement of Principles\n\nSchedule 1 - Dictionary\n\n1 Definitions\n\n \n\n\n\n\n1               Name\n\nThis is the Statement of Principles concerning cirrhosis of the liver (Balance of Probabilities) (No. 2 of 2017).\n\n2               Commencement\n\n              This instrument commences on 23 January 2017.\n\n3               Authority\n\nThis instrument is made under subsection 196B(3) of the Veterans' Entitlements Act 1986.\n\n4               Revocation\n\nThe Statement of Principles concerning cirrhosis of the liver No. 108 of 2007, as amended, made under subsections 196B(3) and (8) of the VEA is revoked.\n\n5               Application\n\nThis instrument applies to a claim to which section 120B of the VEA or section 339 of the Military Rehabilitation and Compensation Act 2004 applies.\n\n6               Definitions\n\nThe terms defined in the Schedule 1 - Dictionary have the meaning given when used in this instrument.\n\n7               Kind of injury, disease or death to which this Statement of Principles relates\n\n(1)          This Statement of Principles is about cirrhosis of the liver and death from cirrhosis of the liver.\n\nMeaning of cirrhosis of the liver\n\n(2)          For the purposes of this Statement of Principles, cirrhosis of the liver means a chronic condition of the hepatic parenchyma involving severe fibrosis in association with the formation of regenerative nodules. \n\n(3)          While cirrhosis of the liver attracts ICD‑10‑AM code K70.3, K71.7 or K74.3-K74.6, in applying this Statement of Principles the meaning of cirrhosis of the liver is that given in subsection (2).\n\n(4)          For subsection (3), a reference to an ICD‑10‑AM code is a reference to the code assigned to a particular kind of injury or disease in The International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Australian Modification (ICD‑10‑AM), Ninth Edition, effective date of 1 July 2015, copyrighted by the Independent Hospital Pricing Authority, ISBN 978‑1‑76007‑020‑5.\n\nDeath from cirrhosis of the liver\n\n(5)          For the purposes of this Statement of Principles, cirrhosis of the liver, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's cirrhosis of the liver.\n\nNote: terminal event is defined in the Schedule 1 – Dictionary.\n\n8               Basis for determining the factors\n\nOn the sound medical‑scientific evidence available, the Repatriation Medical Authority is of the view that it is more probable than not that cirrhosis of the liver and death from cirrhosis of the liver can be related to relevant service rendered by veterans or members of the Forces under the VEA, or members under the MRCA.\n\nNote: relevant service is defined in the Schedule 1 – Dictionary.\n\n9               Factors that must exist\n\nAt least one of the following factors must exist before it can be said that, on the balance of probabilities, cirrhosis of the liver or death from cirrhosis of the liver is connected with the circumstances of a person's relevant service:\n\n(1)          for males, consuming at least 150 kilograms of alcohol within any ten year period before the clinical onset of cirrhosis of the liver;\n\nNote: alcohol is defined in the Schedule 1 - Dictionary.               \n\n(2)          for females, consuming at least 75 kilograms of alcohol within any ten year period before the clinical onset of cirrhosis of the liver;\n\nNote: alcohol is defined in the Schedule 1 - Dictionary.             \n\n(3)          having received a cumulative dose of at least 0.4 sievert of ionising radiation to the liver, from internal deposition of a substance which emits alpha particles, before the clinical onset of cirrhosis of the liver;\n\n(4)          having chronic infection with the hepatitis B virus before the clinical onset of cirrhosis of the liver;\n\nNote: chronic infection with the hepatitis B virus is defined in the Schedule 1 - Dictionary.             \n\n(5)          having chronic infection with the hepatitis C virus before the clinical onset of cirrhosis of the liver;\n\nNote: chronic infection with the hepatitis C virus is defined in the Schedule 1 - Dictionary.\n\n(6)          having chronic infection with the hepatitis D virus before the clinical onset of cirrhosis of the liver;\n\nNote: chronic infection with the hepatitis D virus is defined in the Schedule 1 - Dictionary.             \n\n(7)          having infection with the hepatitis E virus before the clinical onset of cirrhosis of the liver;\n\nNote: infection with the hepatitis E virus is defined in the Schedule 1 - Dictionary.             \n\n(8)          having chronic hepatitis before the clinical onset of cirrhosis of the liver;\n\nNote: chronic hepatitis is defined in the Schedule 1 - Dictionary.\n\n(9)          having autoimmune chronic active hepatitis before the clinical onset of cirrhosis of the liver;\n\nNote: autoimmune chronic active hepatitis is defined in the Schedule 1 - Dictionary.\n\n(10)      having steatohepatitis before the clinical onset of cirrhosis of the liver;\n\n(11)      being infected with human immunodeficiency virus, in the presence of chronic infection with the hepatitis B virus or chronic infection with the hepatitis C virus, before the clinical onset of cirrhosis of the liver;\n\nNote: chronic infection with the hepatitis B virus and chronic infection with the hepatitis C virus are defined in the Schedule 1 - Dictionary.\n\n(12)      having evidence of chronic infection with schistosomiasis involving the liver before the clinical onset of cirrhosis of the liver;\n\n(13)      having granulomatous liver disease before the clinical onset of cirrhosis of the liver;\n\nNote: granulomatous liver disease is defined in the Schedule 1 - Dictionary.\n\n(14)      having severe right-sided cardiac failure for a continuous period of at least 12 months, within the five years before the clinical onset of cirrhosis of the liver;\n\nNote: severe right-sided cardiac failure is defined in the Schedule 1 - Dictionary.\n\n(15)      having veno-occlusive disease for a continuous period of at least 12 months, within the five years before the clinical onset of cirrhosis of the liver;\n\nNote: veno-occlusive disease is defined in the Schedule 1 - Dictionary.             \n\n(16)      having a chronic partial or complete blockage to the passage of bile from the intrahepatic biliary system to the duodenum at the time of the clinical onset of cirrhosis of the liver;\n\n(17)      having iron overload involving the liver at the time of the clinical onset of cirrhosis of the liver;\n\nNote: iron overload is defined in the Schedule 1 - Dictionary.             \n\n(18)      having alpha-1 antitrypsin deficiency before the clinical onset of cirrhosis of the liver;\n\n(19)      having Gaucher's disease before the clinical onset of cirrhosis of the liver;\n\n(20)      having Wilson's disease before the clinical onset of cirrhosis of the liver;\n\n(21)      having Budd-Chiari syndrome for a continuous period of at least 12 months, within the five years before the clinical onset of cirrhosis of the liver;\n\nNote: Budd-Chiari syndrome is defined in the Schedule 1 - Dictionary.             \n\n(22)      consuming a daily average of at least 15 milligrams of vitamin A for a period of at least 18 months, or a cumulative dose of at least eight grams, within the ten years before the clinical onset of cirrhosis of the liver;\n\n(23)      being treated with methotrexate:\n\n(a)           for at least the 12 months; or\n\n(b)           to a cumulative dose of methotrexate of at least one gram taken over at least a six month period,\n\nbefore the clinical onset of cirrhosis of the liver;\n\n(24)      being treated with dideoxynucleoside-analogue drugs as specified for at least 12 months before the clinical onset of cirrhosis of the liver;\n\nNote: dideoxynucleoside-analogue drugs as specified is defined in the Schedule 1 - Dictionary.\n\n(25)      inhaling or having cutaneous contact with carbon tetrachloride for a cumulative period of at least 1 000 hours within the five years before the clinical onset of cirrhosis of the liver;\n\n(26)      for males, consuming at least 150 kilograms of alcohol within any ten year period before the clinical worsening of cirrhosis of the liver;\n\nNote: alcohol is defined in the Schedule 1 - Dictionary.               \n\n(27)      for females, consuming at least 75 kilograms of alcohol within any ten year period before the clinical worsening of cirrhosis of the liver;\n\nNote: alcohol is defined in the Schedule 1 - Dictionary.             \n\n(28)      having received a cumulative dose of at least 0.4 sievert of ionising radiation to the liver, from internal deposition of a substance which emits alpha particles, before the clinical worsening of cirrhosis of the liver;\n\n(29)      having chronic infection with the hepatitis B virus before the clinical worsening of cirrhosis of the liver;\n\nNote: chronic infection with the hepatitis B virus is defined in the Schedule 1 - Dictionary.             \n\n(30)      having chronic infection with the hepatitis C virus before the clinical worsening of cirrhosis of the liver;\n\nNote: chronic infection with the hepatitis C virus is defined in the Schedule 1 - Dictionary.\n\n(31)      having chronic infection with the hepatitis D virus before the clinical worsening of cirrhosis of the liver;\n\nNote: chronic infection with the hepatitis D virus is defined in the Schedule 1 - Dictionary.             \n\n(32)      having infection with the hepatitis E virus before the clinical worsening of cirrhosis of the liver;\n\nNote: infection with the hepatitis E virus is defined in the Schedule 1 - Dictionary.             \n\n(33)      having chronic hepatitis before the clinical worsening of cirrhosis of the liver;\n\nNote: chronic hepatitis is defined in the Schedule 1 - Dictionary.\n\n(34)      having autoimmune chronic active hepatitis before the clinical worsening of cirrhosis of the liver;\n\nNote: autoimmune chronic active hepatitis is defined in the Schedule 1 - Dictionary.\n\n(35)      having steatohepatitis before the clinical worsening of cirrhosis of the liver;\n\n(36)      being infected with human immunodeficiency virus, in the presence of chronic infection with the hepatitis B virus or chronic infection with the hepatitis C virus, before the clinical worsening of cirrhosis of the liver;\n\nNote: chronic infection with the hepatitis B virus and chronic infection with the hepatitis C virus are defined in the Schedule 1 - Dictionary.\n\n(37)      having evidence of chronic infection with schistosomiasis involving the liver before the clinical worsening of cirrhosis of the liver;\n\n(38)      having granulomatous liver disease before the clinical worsening of cirrhosis of the liver;\n\nNote: granulomatous liver disease is defined in the Schedule 1 - Dictionary.\n\n(39)      having severe right-sided cardiac failure for a continuous period of at least 12 months, within the five years before the clinical worsening of cirrhosis of the liver;\n\nNote: severe right-sided cardiac failure is defined in the Schedule 1 - Dictionary.\n\n(40)      having veno-occlusive disease for a continuous period of at least 12 months, within the five years before the clinical worsening of cirrhosis of the liver;\n\nNote: veno-occlusive disease is defined in the Schedule 1 - Dictionary.             \n\n(41)      having a chronic partial or complete blockage to the passage of bile from the intrahepatic biliary system to the duodenum at the time of the clinical worsening of cirrhosis of the liver;\n\n(42)      having iron overload involving the liver at the time of the clinical worsening of cirrhosis of the liver;\n\nNote: iron overload is defined in the Schedule 1 - Dictionary.             \n\n(43)      having alpha-1 antitrypsin deficiency before the clinical worsening of cirrhosis of the liver;\n\n(44)      having Gaucher's disease before the clinical worsening of cirrhosis of the liver;\n\n(45)      having Wilson's disease before the clinical worsening of cirrhosis of the liver;\n\n(46)      having Budd-Chiari syndrome for a continuous period of at least 12 months, within the five years before the clinical worsening of cirrhosis of the liver;\n\nNote: Budd-Chiari syndrome is defined in the Schedule 1 - Dictionary.             \n\n(47)      consuming a daily average of at least 15 milligrams of vitamin A for a period of at least 18 months, or a cumulative dose of at least eight grams, within the ten years before the clinical worsening of cirrhosis of the liver;\n\n(48)      being treated with methotrexate:\n\n(a)           for at least the 12 months; or\n\n(b)           to a cumulative dose of methotrexate of at least one gram taken over at least a six month period,\n\nbefore the clinical worsening of cirrhosis of the liver;\n\n(49)      being treated with dideoxynucleoside-analogue drugs as specified for at least 12 months before the clinical worsening of cirrhosis of the liver;\n\nNote: dideoxynucleoside-analogue drugs as specified is defined in the Schedule 1 - Dictionary.\n\n(50)      inhaling or having cutaneous contact with carbon tetrachloride for a cumulative period of at least 1 000 hours within the five years before the clinical worsening of cirrhosis of the liver;\n\n(51)      inability to obtain appropriate clinical management for cirrhosis of the liver.\n\n10           Relationship to service\n\n(1)          The existence in a person of any factor referred to in section 9, must be related to the relevant service rendered by the person.\n\n(2)          The factors set out in subsections 9(26) to 9(51) apply only to material contribution to, or aggravation of, cirrhosis of the liver where the person's cirrhosis of the liver was suffered or contracted before or during (but did not arise out of) the person's relevant service.\n\n11           Factors referring to an injury or disease covered by another Statement of Principles\n\nIn this Statement of Principles:\n\n(1)          if a factor referred to in section 9 applies in relation to a person; and\n\n(2)          that factor refers to an injury or disease in respect of which a Statement of Principles has been determined under subsection 196B(3) of the VEA;\n\nthen the factors in that Statement of Principles apply in accordance with the terms of that Statement of Principles as in force from time to time.\n\n \n\n \n\nSchedule 1 - Dictionary  \n\nNote:               See Section 6\n\n1               Definitions\n\nIn this instrument:\n\n                               alcohol is measured by the alcohol consumption calculations utilising the Australian Standard of ten grams of alcohol per standard alcoholic drink.\n\n                               autoimmune chronic active hepatitis means a chronic disorder of autoimmunity characterised by continuing hepatocellular necrosis and inflammation and seroimmunologic abnormalities.\n\n                               Budd-Chiari syndrome means symptomatic obstruction or occlusion of the hepatic veins or hepatic portion of the inferior vena cava, characterised by hepatomegaly, abdominal pain and tenderness, ascites, mild jaundice, and eventually, portal hypertension and liver failure.\n\n                               chronic hepatitis means symptomatic, biochemical or infectious agent biomarker evidence of continuing or relapsing hepatocellular necrosis and hepatic inflammation for at least six months.\n\n                               chronic infection with the hepatitis B virus means infection with the hepatitis B virus resulting in a chronic infection of at least six months duration and which must be confirmed by laboratory testing for hepatitis B serological or nucleic acid markers, or both.\n\n                               chronic infection with the hepatitis C virus means infection with the hepatitis C virus resulting in a chronic infection of at least six months duration and which must be confirmed by laboratory testing for hepatitis C serological or nucleic acid markers, or both.\n\n                               chronic infection with the hepatitis D virus means infection with the hepatitis D virus resulting in a chronic infection of at least six months duration and which must be confirmed by laboratory testing for hepatitis D serological or nucleic acid markers, or both.\n\n                             cirrhosis of the liver—see subsection 7(2).\n\n                               dideoxynucleoside-analogue drugs as specified means didanosine, stavudine or zalcitabine.\n\n                               granulomatous liver disease means an inflammatory liver disease characterised by granuloma formation in the liver and associated with many disorders such as sarcoidosis, infections (tuberculosis, brucellosis, syphilis), and adverse drug reactions.\n\n                               infection with the hepatitis E virus means infection with the hepatitis E virus resulting in an infection of at least six months duration and which must be confirmed by laboratory testing for hepatitis E serological or nucleic acid markers, or both.\n\n                             iron overload means an accumulation of excess iron in tissues and organs which has been confirmed by elevated ferritin or transferrin saturation levels.  Causes include haemochromatosis and blood transfusions.\n\n                             MRCA means the Military Rehabilitation and Compensation Act 2004.\n\n                             relevant service means:\n\n(a)          eligible war service (other than operational service) under the VEA;\n\n(b)          defence service (other than hazardous service and British nuclear test defence service) under the VEA; or\n\n(c)          peacetime service under the MRCA.\n\nNote: MRCA and VEA are also defined in the Schedule 1 - Dictionary.\n\n                             severe right-sided cardiac failure means a reduced ability of the right ventricle to process venous return, evidenced by marked venous and liver congestion and extensive peripheral oedema.\n\n                             terminal event means the proximate or ultimate cause of death and includes the following:\n\n(a)           pneumonia;\n\n(b)           respiratory failure;\n\n(c)           cardiac arrest;\n\n(d)           circulatory failure; or\n\n(e)           cessation of brain function.\n\n                             VEA means the Veterans' Entitlements Act 1986.\n\n                             veno-occlusive disease means symptomatic occlusion of the sublobular branches of the hepatic veins or the small hepatic venules.\n\n \n\n \n","sortOrder":0}],"analysis":{"kimi_summary":{"content_quality":"ok","complexity_score":4,"scope_assessment":{"changed":false,"description":"This instrument appears to maintain the standard scope of Repatriation Medical Authority Statements of Principles. It replaces a 2007 version with updated medical evidence and ICD-10-AM coding references, but does not expand beyond the traditional purpose of establishing service connection for a specific disease. The structure of 50+ factors covering onset and worsening is typical of RMA instruments."},"complexity_factors":["25 defined medical terms in Schedule 1, many requiring specific laboratory confirmation or clinical thresholds","51 distinct factors with precise quantitative thresholds (e.g., '150 kilograms of alcohol', '0.4 sievert', '1,000 hours', '12 months continuous')","Bifurcated structure: factors 1-25 for clinical onset vs 26-50 for clinical worsening, with factor 51 as a standalone exception","Cross-referencing mechanism in section 11 allowing incorporation of other Statements of Principles by reference","Gender-specific thresholds for alcohol consumption (male/female split in factors 1-2 and 26-27)","Temporal constraints requiring specific lookback periods (5 years, 10 years, 'within', 'before')","Nested definitions: some defined terms rely on other defined terms (e.g., 'relevant service' incorporates 'eligible war service', 'defence service', 'peacetime service')","Medical jargon requiring specialist knowledge (e.g., 'steatohepatitis', 'veno-occlusive disease', 'dideoxynucleoside-analogue drugs')"],"plain_english_summary":"This rulebook from the Repatriation Medical Authority sets when cirrhosis of the liver is considered connected to Australian military service for veterans and current/former defence members, replacing the 2007 version. It lists 51 medical factors—covering heavy alcohol use, infections (hepatitis, HIV combos, schistosomiasis), genetic/metabolic diseases, heart/biliary causes, and environmental or treatment exposures—and says cirrhosis is service‑connected if at least one factor applies and relates to service. It matters because it determines entitlement to taxpayer‑funded treatment and compensation."},"flash_summary_failed":{"failed":true,"reason":"A positive credit balance is required for all requests, including BYOK, so fallback providers remain available. Add credits at https://vercel.com/d?to=%2F%5Bteam%5D%2F%7E%2Fai%3Fmodal%3Dtop-up to continue.","source":"analysis-cron"},"flash_summary":{"complexity_score":4,"scope_assessment":{"changed":true,"description":"The instrument expressly revokes the earlier Statement of Principles No.108 of 2007 (s4) and replaces it with updated criteria. It preserves application to VEA and MRCA claims (s5) but modifies and adds factors and timing rules (see expanded clinical worsening provisions s9(26)–(51), the new factor for inability to obtain appropriate clinical management s9(51), and clarified ICD/code and definition references s7(3)–(4), Schedule 1). These amendments change how cirrhosis claims are assessed against service."},"complexity_factors":["Detailed, medicalised thresholds and measures (e.g. alcohol consumption in kilograms for males/females: s9(1),(2),(26),(27); vitamin A and methotrexate dose rules: s9(22),(48))","Multiple, overlapping causal categories (infectious, toxic, genetic, obstructive, cardiac and drug‑related causes across s9(3)–(25) and s9(28)–(50))","Timing distinctions between clinical onset and clinical worsening and service relationship limits (s7(2),(5); s9; s10(2))","Dependence on laboratory/clinical confirmation and defined terms in the Schedule 1 dictionary (definitions for chronic infections, iron overload, etc.)","Interactions with other Statements of Principles where factors refer to injuries covered elsewhere (s11)","Revocation and replacement of an earlier Statement (s4), requiring practitioners and decision‑makers to apply the updated text (s5)","A residual, non‑medical factor expanding scope to management access (inability to obtain appropriate clinical management: s9(51))"],"plain_english_summary":"This Statement of Principles, made by the Repatriation Medical Authority, sets the medical criteria used to decide whether cirrhosis of the liver (or death from it) is connected to a person’s service for claims under the Veterans' Entitlements Act and the Military Rehabilitation and Compensation Act. It lists specific causal factors (alcohol thresholds, infections, toxins, drugs, genetic and obstructive liver conditions, and management gaps) and timing rules that decision‑makers must apply when determining entitlement to benefits."}},"importantCases":[],"_links":{"self":"/api/acts/statement-of-principles-concerning-cirrhosis-of-the-liver-balance-of-probabilities-no-2-of-2017","history":"/api/acts/statement-of-principles-concerning-cirrhosis-of-the-liver-balance-of-probabilities-no-2-of-2017/history","analysis":"/api/acts/statement-of-principles-concerning-cirrhosis-of-the-liver-balance-of-probabilities-no-2-of-2017/analysis","conflicts":"/api/acts/statement-of-principles-concerning-cirrhosis-of-the-liver-balance-of-probabilities-no-2-of-2017/conflicts","importantCases":"/api/acts/statement-of-principles-concerning-cirrhosis-of-the-liver-balance-of-probabilities-no-2-of-2017/important-cases","documents":"/api/acts/statement-of-principles-concerning-cirrhosis-of-the-liver-balance-of-probabilities-no-2-of-2017/documents"}}